1 in 4 @JUULvapor tweeps is underage, a #PublicHealth concern

VIDEO: In this illustrative gif, a young-looking person follows @JUULvapor while charging a JUUL. A University of Pittsburgh study found that 1 in 4 @JUULvapor followers is an adolescent, despite statements...
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Credit: Nate Langer/UPMC

PITTSBURGH, Oct. 19, 2018 - E-cigarette brand JUUL's Twitter handle is attracting adolescents to the point that at least a quarter of its followers appear to be under age 18, according to a new analysis by the University of Pittsburgh School of Medicine.

Many of these minors - to whom it is illegal to sell nicotine-delivery products - are retweeting JUUL's messages, amplifying its advertisements to a vulnerable population. The study results are published today in the Journal of Adolescent Health.

"JUUL representatives have said the company is not trying to target adolescents with their advertising or sales, but our research clearly indicates that a sizeable proportion of their Twitter audience is exactly this population," said lead author Kar-Hai Chu, Ph.D., assistant professor of medicine in Pitt's Center for Research on Media, Technology and Health. "This is highly concerning because adolescents exposed to e-cigarette marketing are more likely to use e-cigarettes and, in turn, young adults who use e-cigarettes are four times as likely as their non-vaping peers to transition to smoking traditional tobacco cigarettes."

JUUL (pronounced "jewel") is an e-cigarette that resembles a flash drive and can be plugged into a computer to recharge. A "pod" of e-liquid containing nicotine is loaded into the JUUL and heated, with the user inhaling the vapor. JUUL vapor contains about double the concentration of nicotine found in other e-cigarettes and comes in several youth-friendly flavors, including mango and fruit medley.

There is evidence that adolescents, whose brains are still developing, are more susceptible to nicotine addiction than adults. Nine out of every 10 cigarette smokers started before age 18, according to the U.S. Centers for Disease Control and Prevention.

Chu and his colleagues launched the analysis after noticing that JUUL was particularly appealing to teens, and those teens were using social media to discuss how to obtain it and hide using it while in school. Using terms like "juuling" and customizing the appearance of the devices have also become part of youth culture. Twitter has a gateway feature that can perform age screening and discourage underage followers - many alcohol brands employ it - but JUUL isn't using it.

The research team collected 3,239 tweets from JUUL's official Twitter account, @JUULvapor, for a year between February 2017 and January 2018. These tweets were retweeted 1,124 times by 721 unique Twitter users. Trained human coders examined each of the user's Twitter profiles to determine if the individual was under age 18. If the user shared an age, that made the job easy. If not, the coders looked for clues - such as if the user mentioned a grade level or an age-specific event, like, "I'm excited about my upcoming sweet 16." If there was any doubt, the user was labeled an adult.

When a person retweets, the original tweet is shared with all of that person's followers, even if none of them follows the handle that issued the original tweet. In the JUUL tweets that the researchers examined, some were retweeted in a chain that extended through four Twitter users.

"When this happens, the people seeing the retweet are getting it from a person, not a brand. It adds a level of normalization and buffers the viewers from the impersonal element of advertising, particularly if the person who retweeted it is a trusted friend or someone they aspire to be like," said Chu.

Public health agencies could execute similar social media analyses to find adolescent networks that are popularizing e-cigarette use and target counter-messaging to them, even going so far as to identify schools associated with the social media accounts of students who glamorize vaping and institute programs to prevent e-cigarette use, Chu said. Further research should be performed to determine if such preventive efforts are effective, he added.

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Additional authors on this research are Jason B. Colditz, M.Ed., Brian A. Primack, M.D., Ph.D., Ariel Shensa, M.A., and Elizabeth Miller, M.D., Ph.D., all of Pitt; and Jon-Patrick Allem, Ph.D., Jennifer B. Unger, Ph.D., and Tess Boley Cruz, Ph.D., all of the University of Southern California.

This research was funded by National Cancer Institute grants R01-CA225773, K07-CA222338 and P50-CA180905, with support from the Food and Drug Administration Center for Tobacco Products, as well as the Eunice Kennedy Shriver National Institute of Child Health and Development grant K24-HD075862.

About the University of Pittsburgh Schools of the Health Sciences

The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health. For additional information about the Schools of the Health Sciences, please visit http://www.health.pitt.edu.

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